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Storer D, Holt M, Paparini S, Haire B, Cornelisse VJ, MacGibbon J, Broady TR, Lockwood T, Delpech V, McNulty A, Smith AKJ. Informed, but uncertain: managing transmission risk and isolation in the 2022 mpox outbreak among gay and bisexual men in Australia. CULTURE, HEALTH & SEXUALITY 2024:1-16. [PMID: 38756104 DOI: 10.1080/13691058.2024.2346540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 04/19/2024] [Indexed: 05/18/2024]
Abstract
In 2022, a global outbreak of mpox (formerly 'monkeypox') emerged in non-endemic countries, including Australia, predominantly affecting gay, bisexual and other men who have sex with men. Public health advice on transmission and isolation emerged rapidly from different sources, sometimes conflicting and producing uncertainty. Using the concept of 'counterpublic health', which acknowledges the incorporation of official science and experiences of affected communities into embodied practice, this paper investigates how people affected by mpox in Australia managed risk of transmission and navigated self-isolation. In-depth interviews were conducted with 16 people: 13 people diagnosed with mpox and three close contacts. All participants were cisgender gay and bisexual men living in Australia. Participants thought critically about public health advice, often finding it restrictive and unresponsive to the needs of people with mpox. Participants' decisions about reducing mpox risk and isolating often drew on experiences with other infections (i.e. HIV; COVID-19) and were made collaboratively with the people closest to them (e.g. partners, friends, family) to sustain relationships. Future public health responses to infectious disease outbreaks would benefit from identifying more opportunities to formalise and embed mechanisms to obtain feedback from affected communities so as to inform responses.
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Affiliation(s)
- Daniel Storer
- School of Population Health, UNSW Sydney, Sydney, Australia
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Sara Paparini
- SHARE Collaborative, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Bridget Haire
- School of Population Health, UNSW Sydney, Sydney, Australia
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, Australia
| | - Vincent J Cornelisse
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- New South Wales Health, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Valerie Delpech
- Mid North Coast Local Health District, Coffs Harbour, Australia
| | - Anna McNulty
- New South Wales Health, Sydney, Australia
- Sydney Sexual Health Centre, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
- Australian Human Rights Institute, UNSW Sydney, Sydney, Australia
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2
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Brisson JB, Grace D, Perez-Brumer AG. Collective antiretroviral protection: new dimensions of community HIV prevention practices at the intersection of U=U and PrEP. Lancet HIV 2024; 11:e341-e344. [PMID: 38513674 DOI: 10.1016/s2352-3018(24)00034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 03/23/2024]
Abstract
Collective antiretroviral protection is an evolving sexual health strategy in HIV prevention, used in particular by gay, bisexual, and other men who have sex with men. The strategy involves HIV-negative individuals who engage in condomless sexual activities but, instead of using pre-exposure prophylaxis (PrEP) themselves, choose partners who either have undetectable viral loads or are on PrEP. This biomedical-sorting practice, rooted in the scientific principles of undetectable equals untransmittable (U=U) and PrEP, relies on an indirect protection strategy. Collective antiretroviral protection allows for HIV-negative individuals not on PrEP to benefit from their partner's antiretroviral use, without directly consuming antiretrovirals themselves for HIV prevention, during condomless sex. Empirical research is needed to evaluate the public health implications of this emerging sexual health approach. Research and public health initiatives should adopt a non-stigmatising approach to individuals engaging in collective antiretroviral protection and look beyond individual behaviour to understand the broader community-level effects of this innovative HIV prevention strategy.
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Affiliation(s)
- Julien B Brisson
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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3
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Yang L, Sun Z. Are All Gay Men at Risk of Developing HIV/AIDS? Why China's Mass HIV Testing Has Majorly Targeted Gay Men in the Era of Biomedicalization. Am J Mens Health 2024; 18:15579883241230165. [PMID: 38321807 PMCID: PMC10851740 DOI: 10.1177/15579883241230165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Global HIV/AIDS responses have been increasingly biomedically dominated over the past years. In line with this shifting paradigm, China has prioritized mass HIV testing as a practical approach to controlling its HIV/AIDS epidemics among at-risk populations, especially gay men and other men who have sex with men (MSM). This study analyzed why China's mass HIV testing mainly targeted gay men by understanding the perspectives of public health professionals, community-based organization (CBO) workers, and gay men. In addition, this study revealed the tensions and unintended consequences of HIV/AIDS prevention and the representation of gay men in China. The study involved fieldwork conducted in a major city in Eastern China from 2015 to 2019. Semi-structured interviews were held with participants from the three abovementioned groups (N = 25). The study identified four processes concerning why gay men are mainly targeted for HIV testing. Some public health professionals believe that being a gay man is equivalent to having HIV/AIDS risks. In addition, this study particularly noted tensions between public health professionals and gay men, including gay men-identified CBO workers, over whether mass HIV testing should target gay men or anyone who engaged in sexual risk behaviors. This study argued that a particular focus on gay men due to pursuing biomedical advances in HIV/AIDS prevention seems to have unintendedly stereotyped gay men based on the presumptions that they are at risk of developing HIV/AIDS. In addition, this study corresponded to the broader social scientific discussion concerning whether HIV/AIDS intervention should target specific sexual risk practices or sexual identity/population.
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Affiliation(s)
- Lei Yang
- School of Public Administration, Beihang University, Beijing, P.R. China
| | - Zhipeng Sun
- Shanghai Technician School; Higher Vocational and Technical College, Shanghai University of Engineering Science, Shanghai, P.R. China
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4
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Wang M. Safe on Blued? A Qualitative Exploration of Sex, Risk, and Stigma on a Gay Social Application in China. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2023; 35:596-607. [PMID: 38601809 PMCID: PMC10903620 DOI: 10.1080/19317611.2023.2260797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 09/14/2023] [Indexed: 04/12/2024]
Abstract
Introduction Mobile dating apps emerged with the development of technology, for example, Blued in China, becoming a new risk field for gay men in the AIDS era. Users use social apps to chat online and date offline to achieve the satisfaction of lust or sexual practice, but the risk of AID looms over the whole process of using apps. Methods Nineteen interviewees were invited to participate in this study, which included gay men who were using or had used Blued. The content of the semi-structured interviews focused on the relationship between gay social apps and HIV risk. Results The study finds Blued interweaved with sex, risk, and stigma. Blued is sexualized due to sexual intentions and practices. There is also a sexual stratification of risk with Blued and its users based on socioeconomic factors. Users experience a dilemma between pursuing sex while being concerned about latent risk within a context of stigmatization. Conclusions Blued is sexualized in terms of the process of stimulating sexual gratification and facilitating sexual practices. The experience of Blued is an example of sexual stratification, and a structure of desire based on app users and app uses. Furthermore, the social stigma against men who have sex with men is transferred to Blued, which bears the stigma of "AIDS-Blued" with a dual stigma-HIV-related and homosexual stigma. However, with the authorized approval of Blued in public health, Blued could play an essential role in HIV/AIDS prevention and control.
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Affiliation(s)
- Ming Wang
- School of Social Development, East China Normal University, Shanghai, China
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5
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Murphy D, Ellard J, Maher L, Saxton P, Holt M, Haire B, Grulich A, Bavinton B, Philpot S, Bourne A, Storer D, Jin F, Hammoud M, Prestage G. How to have sex in a pandemic: the development of strategies to prevent COVID-19 transmission in sexual encounters among gay and bisexual men in Australia. CULTURE, HEALTH & SEXUALITY 2023; 25:271-286. [PMID: 35192436 DOI: 10.1080/13691058.2022.2037717] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/31/2022] [Indexed: 06/14/2023]
Abstract
Although many studies reported on decreases in sexual partner numbers among gay and bisexual-identifying men in the early period of the COVID-19 pandemic, few studies have explored COVID-19 risk-reduction strategies. Drawing on free-text responses in an online survey (from April to July 2020), we describe the ways in which men sought to minimise the risk of COVID-19 in sexual encounters. Partner selection was an important strategy, in particular, restricting sex to men they already knew. Accounts also indicate how participants assessed risk from potential sex partners based on symptoms, residential location, recent travel, work role, and number of other sexual contacts. Less common were in situ practices, such as avoiding kissing. Participants' responses provide insight into creative community-based responses in the early months of the pandemic, some of which have resonances with early responses to HIV. Findings are discussed in relation to the concepts of 'lay epidemiology' and 'counterpublic health'. In particular, we examine how risks and health are experienced and valued in relation to local knowledges, meanings, and practices; and how practices emerge in response to dominant public health discourses that produce an idealised public based on (hetero)normative assumptions.
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Affiliation(s)
- Dean Murphy
- The Kirby Institute, UNSW Sydney, NSW, Australia
| | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, NSW, Australia
| | - Peter Saxton
- Department of Social and Community Health, University of Auckland, Auckland, New Zealand
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, NSW, Australia
| | | | | | | | | | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, VIC, Australia
| | | | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, NSW, Australia
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6
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Hammoud MA, Wells N, Holt M, Bavinton B, Jin F, Maher L, Philpot S, Haire B, Degenhardt L, Bourne A, Saxton P, Keen P, Storer D, Prestage G. COVID-19 Testing in a Weekly Cohort Study of Gay and Bisexual Men: The Impact of Health-Seeking Behaviors and Social Connection. AIDS Behav 2023; 27:948-956. [PMID: 36048292 PMCID: PMC9434557 DOI: 10.1007/s10461-022-03831-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2022] [Indexed: 12/01/2022]
Abstract
Gay, bisexual, and other men who have sex with men (GBM) have developed community norms for regular HIV/STI testing. We investigated factors associated with self-reported COVID-19 testing in response to reported COVID-19 cases and public health restrictions. Participants responded to weekly cohort surveys between 10th May 2021 and 27th September 2021. We used the Andersen-Gill extensions to the Cox proportional hazards model for multivariable survival data to predict factors influencing COVID-19 testing. Mean age of the 942 study participants was 45.6 years (SD: 13.9). In multivariable analysis, GBM were more likely to report testing during periods of high COVID-19 caseload in their state of residence; if they were younger; university educated; close contact of someone with COVID-19; or reported coping with COVID-19 poorly. COVID-19 testing was higher among men who: were more socially engaged with other GBM; had a higher proportion of friends willing to vaccinate against COVID-19; and were willing to contact sexual partners for contact tracing. Social connection with other gay men was associated with COVID-19 testing, similar to what has been observed throughout the HIV epidemic, making community networks a potential focus for the promotion of COVID-19 safe practices.
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Affiliation(s)
- Mohamed A Hammoud
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia.
| | - Nathanael Wells
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Benjamin Bavinton
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Fengyi Jin
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Steven Philpot
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Bridget Haire
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
| | - Peter Saxton
- Department of Social and Community Health, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Phillip Keen
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Daniel Storer
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
| | - Garrett Prestage
- Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building UNSW, 2052, Sydney, Australia
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Hentges B, Knauth DR, Vigo A, Teixeira LB, Leal AF, Kendall C, Magno L, Dourado I, Kerr L. Inconsistent condom use with casual partners among men who have sex with men in Brazil: a cross-sectional study. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230019. [PMID: 36995830 PMCID: PMC10041745 DOI: 10.1590/1980-549720230019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/04/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE This study aimed to evaluate factors associated with inconsistent condom use with casual partners in a population of men who have sex with men (MSM) in Brazil. METHODS In 2016, 4,176 MSM >18 years were enrolled in 12 capitals of Brazil using a Respondent Driven Sampling (RDS) method. For the construction of the outcome, we evaluated questions about condom use in all anal intercourse (receptive and insertive) in the previous six months and the last sexual intercourse. Estimates were calculated using a weighted complex sample design. We performed a logistic regression analysis to determine the associations between sociodemographic and behavioral factors and inconsistent condom use in sexual relationships with casual male partners. RESULTS More than half of our sample (50.8%) had not used condoms consistently with casual partners in the previous six months. Inconsistent condom use was significantly associated with: low education (weighted odds ratio - wOR: 1.55; 95% confidence interval - CI 0.99-2.40), lack of counseling on sexually transmitted infections STI (wOR: 1.51; 95%CI 1.05-2.17), non-use of condoms at sexual debut (wOR: 3.05; 95%CI 2.12-4.40) and moderate and high perceived risk for HIV (wOR: 1.51; 95%CI 1.07-2.14). Higher age was negatively associated with inconsistent condom use (wOR=0.97, 95%CI 0.89-0.99). CONCLUSION Despite being an individual behavior, condom use is related to factors beyond the individual scope. HIV/Aids prevention policies should focus on younger MSM, providing qualified information about condom use, preferably before the beginning of their sexual life.
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Affiliation(s)
- Bruna Hentges
- Universidade Federal do Rio Grande do Sul, School of Medicine, Epidemiology Undergraduate Program - Porto Alegre (RS), Brazil
| | - Daniela Riva Knauth
- Universidade Federal do Rio Grande do Sul, Department of Social Medicine - Porto Alegre (RS), Brazil
| | - Alvaro Vigo
- Universidade Federal do Rio Grande do Sul, Department of Statistics - Porto Alegre (RS), Brazil
| | | | - Andréa Fachel Leal
- Universidade Federal do Rio Grande do Sul, Institute of Philosophy and Human Sciences. Porto Alegre (RS), Brazil
| | - Carl Kendall
- Universidade do Ceará, School of Medicine, Department of Collective Health. Fortaleza (CE), Brazil
| | - Laio Magno
- Universidade do Estado da Bahia, Department of Life Sciences, Salvador (BA), Brazil
| | - Inês Dourado
- Universidade Federal da Bahia, Health Collective Institute, Salvador (BA), Brazil
| | - Ligia Kerr
- Universidade Federal do Ceará, Department of Community Health, Fortaleza (CE), Brazil
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8
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Kolstee J, MacGibbon J, Prestage G, Clackett S, Paynter H, Bavinton BR, Broady TR, Ellard J, Murphy DA, de Wit J, Power C, Holt M. Changing Attitudes Towards Condoms Among Australian Gay and Bisexual Men in the PrEP Era: An Analysis of Repeated National Online Surveys 2011-2019. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:453-466. [PMID: 36454135 DOI: 10.1521/aeap.2022.34.6.453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Condoms have been the primary form of HIV prevention for gay and bisexual men (GBM) for most of the HIV epidemic. The introduction of biomedical HIV prevention may have changed attitudes towards condoms. Data from repeated national online surveys of GBM in Australia were used to examine how attitudes towards condoms and confidence discussing condoms with partners changed in the period 2011-2019. The proportion of all participants who reported a positive experience in using condoms remained low and unchanged (9.6% in 2011 to 6.0% in 2019). Confidence in discussing condoms with partners decreased over time (from 72.2% in 2011 to 56.6% in 2019). Confidence in discussing condoms was associated with concern about sexually transmitted infections, and more consistent condom use. Sustaining confidence in using condoms may be more challenging as biomedical prevention methods become more commonly used.
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Affiliation(s)
| | - James MacGibbon
- Centre for Social Research in Health, UNSW Sydney, Australia
| | | | | | - Heath Paynter
- Australian Federation of AIDS Organisations, Sydney, Australia
| | | | | | - Jeanne Ellard
- Australian Research Centre in Sex, Health and Society, La Trobe University, Bundoora, Australia
| | | | - John de Wit
- Kirby Institute, UNSW Sydney, Australia
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | | | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Australia
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9
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Gaspar M, Wells A, Hull M, Tan DHS, Lachowsky N, Grace D. "What other choices might I have made?": Sexual Minority Men, the PrEP Cascade and the Shifting Subjective Dimensions of HIV Risk. QUALITATIVE HEALTH RESEARCH 2022; 32:1315-1327. [PMID: 35616240 PMCID: PMC9350448 DOI: 10.1177/10497323221092701] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The PrEP Cascade is a dominant framework for investigating barriers to HIV pre-exposure prophylaxis (PrEP), an HIV prevention tool. We interviewed 37 PrEP users and 8 non-PrEP users in Ontario and British Columbia, Canada, about their decision-making through the Cascade. Participants were HIV-negative gay, bisexual, and queer men (GBQM). The data were analyzed using thematic analysis. PrEP decision-making was based on pragmatic considerations (logistics, costs, and systemic barriers), biomedical considerations (efficacy, side-effects, and sexually transmitted infections), and subjective considerations (identity, politics, and changing sexual preferences). Affective attachments to established versions of "safer sex" (condoms and serosorting) made some GBQM less likely to try PrEP. Some GBQM expressed increased social expectations to use PrEP, have condomless sex, and serodifferent sex. These findings support offering PrEP at no-cost, offering individualized counseling and community-based opportunities to discuss PrEP use and changing sexual practices, and improving communication on the manageability of PrEP side-effects.
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Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
| | - Alex Wells
- University of Victoria, Victoria, BC,
Canada
| | - Mark Hull
- University of British Columbia,
Vancouver, BC, Canada
| | - Darrell H. S. Tan
- St. Michael’s Hospital and University
of Toronto, Toronto, ON, Canada
| | | | - Daniel Grace
- Dalla Lana School of Public Health,
University of Toronto, Toronto, ON, Canada
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10
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Chan C, Bavinton BR, Prestage GE, Broady TR, Mao L, Rule J, Wilcock B, Holt M. Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2509-2521. [PMID: 35672592 PMCID: PMC9293873 DOI: 10.1007/s10508-022-02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/30/2023]
Abstract
Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.
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Affiliation(s)
- Curtis Chan
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Garrett E Prestage
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australia Federation of AIDS Organisations, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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11
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Truong HHM, Fatch R, McFarland W, Grasso M, Raymond HF, Holt M, Steward WT. Destination-Specific and Home Environment Condom Norms Influence Sexual Behavior During Travel. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:245-255. [PMID: 35647868 PMCID: PMC10654111 DOI: 10.1521/aeap.2022.34.3.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Travelers may adapt HIV risk-reduction practices based on perceived destination-specific norms. We examined the association between perceived condom norms and condomless anal sex (CAS) during international and domestic travel and in the home environment among men who have sex with men. Men who traveled internationally in the past 12 months were recruited by respondent-driven sampling (N = 501). Not knowing destination-specific condom norms was significantly associated with less CAS during international travel and in the home environment but not during domestic travel. Perceiving home environment condom norms to expect use of condoms was significantly associated with less CAS during domestic but not international travel. Men were less likely to engage in CAS during international travel when destination-specific condom norms were unknown. Unfamiliarity with the environment and culture may influence some men to refrain from higher-risk behaviors. During domestic travel, some men appeared to apply home environment condom norms, which may be erroneous in some situations and pose an HIV risk.
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Affiliation(s)
| | | | - Willi McFarland
- University of California San Francisco
- California Department of Public Health
| | | | | | - Martin Holt
- University of New South Wales, Sydney, Australia
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12
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Diversity via datafication? Digital patient records and citizenship for sexuality and gender diverse people. BIOSOCIETIES 2022. [DOI: 10.1057/s41292-022-00277-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AbstractIn 2018, the Australian Government adopted an ‘opt-out’ strategy to increase participation in My Health Record (MHR), the national digital patient record system. Opt out was rationalised through discourse on the universal right to health. Media controversy ensued due to privacy fears, security and commercial exploitation of patient information. LGBT community organisations warned that people with complex health needs should consider their privacy and legal situation when deciding whether or not to opt out of MHR. With reference to the health needs of sexuality and gender diverse people, we examine MHR’s rights universalism, possessive individualism, and state-based rationalisation of health governance. MHR hails all but no-one in particular, erasing diversity and straightwashing data medicine. It is a technological solution to state-based imperatives for health governance, an emphasis that does not serve minority communities or address health needs that attract stigma and prejudice. We counterpose these effects with citizenship framings seated in critical approaches to data assemblages and sexuality and gender diversity. We suggest ways in which data medicine, of which MHR is but one example, can be made more relevant and effective for individuals and communities whose healthcare is poorly served by mainstream health systems.
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13
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Gaspar M, Grey C, Wells A, Hull M, Tan DHS, Lachowsky N, Grace D. Public health morality, sex, and COVID-19: sexual minority men’s HIV pre-exposure prophylaxis (PrEP) decision-making during Ontario’s first COVID-19 lockdown. CRITICAL PUBLIC HEALTH 2021. [DOI: 10.1080/09581596.2021.1970720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Mark Gaspar
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | | | - Alex Wells
- University of Victoria, Victoria, Canada
| | - Mark Hull
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | | | | | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Bauquier C, Préau M. Contribution of HIV/AIDS-Related Human and Social Sciences Research to a Better Understanding of the Challenges of Hepatitis B Prevention, Diagnosis and Care. Microorganisms 2021; 9:1166. [PMID: 34071536 PMCID: PMC8230355 DOI: 10.3390/microorganisms9061166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 01/05/2023] Open
Abstract
Recent scientific advances in hepatitis B virus research hint at the possibility of finding a cure in the medium term. In this context, the characterization of infected persons constitutes a major public health issue in terms of implementing adapted screening and prevention strategies. Overcoming the current challenges national health systems face in hepatitis B diagnosis is essential if the World Health Organization's target of treating 80% of infected patients by 2030 is to be reached. These challenges reflect those previously faced in the fight against HIV/AIDS. Using the knowledge produced to date in Human and Social Sciences research in the fight against HIV/AIDS, we propose avenues of reflection to support and guide the development of research in the diagnosis of hepatitis B infection. More specifically, we present theoretical, methodological and epistemological considerations for how HSS research can be optimized in the following three HBV diagnosis-related areas: (i) access to screening; (ii) retention in care; and (iii) the integration of quality of life measurement in clinical trials.
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Affiliation(s)
- Charlotte Bauquier
- Research Group in Social Psychology (GRePS UR 4163), University Lyon 2, 69676 Bron, France;
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Truong HHM, Mehrotra ML, Grant RM. Brief Report: Seroadaptive Behaviors Varied Among Geographically Diverse iPrEx Participants. J Acquir Immune Defic Syndr 2021; 86:e43-e47. [PMID: 33093331 DOI: 10.1097/qai.0000000000002551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Seroadaptive behaviors refer to a wide range of harm reduction practices to decrease HIV transmission risk. Effective implementation of seroadaptive behaviors is dependent on knowledge of one's own serostatus and that of one's sexual partners. Partner-level and environmental-level attributes may affect seroadaptation practices. We assessed factors associated with seroadaptive behaviors. METHODS Men who have sex with men and transgender women were recruited from an HIV pre-exposure prophylaxis clinical trial (iPrEx) with study sites in the US, Peru, Ecuador, Brazil, Thailand, and South Africa. Partnership-level data were collected at the baseline visit for the 3 most recent partners. Participants were considered to have practiced seroadaptive behaviors if: (1) they believed their partner to be HIV-negative, that is, serosorting; or (2) no condomless receptive sex occurred with an HIV-positive or unknown status partner, that is, seropositioning. RESULTS Of 2331 participants, 41% always practiced seroadaptive behaviors, 36% sometimes did, and 23% never did. Participants enrolled at study sites in the US (P < 0.001) and Peru/Ecuador (P < 0.001) were more likely to practice seroadaptive behaviors, whereas transgender women were less likely to do so (P < 0.001). Seroadaptive behaviors were more likely to occur in relationships with steady partners (P = 0.005) and emotionally close relationships (P = 0.013). CONCLUSIONS Seroadaptive behaviors were more frequently observed among iPrEx participants from the US, Peru, and Ecuador study sites and among participants in relationships with partners who they were more committed to and felt emotionally close to. Our findings suggest that seroadaptive behaviors may be influenced by social norms that vary geographically and culturally.
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Affiliation(s)
| | - Megha L Mehrotra
- Epidemiology and Biostatistics, University of California, San Francisco, CA
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McDaid L, Flowers P, Ferlatte O, Young I, Patterson S, Gilbert M. Sexual health literacy among gay, bisexual and other men who have sex with men: a conceptual framework for future research. CULTURE, HEALTH & SEXUALITY 2021; 23:207-223. [PMID: 32118515 DOI: 10.1080/13691058.2019.1700307] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
Good sexual health requires navigating intimate relationships within diverse power dynamics and sexual cultures, coupled with the complexities of increasing biomedicalisation of sexual health. Understanding this is important for the implementation of biomedical HIV prevention. We propose a socially nuanced conceptual framework for sexual health literacy developed through a consensus building workshop with experts in the field. We use rigorous qualitative data analysis to illustrate the functionality of the framework by reference to two complementary studies. The first collected data from five focus groups (FGs) in 2012 (n = 22), with gay, bisexual and other men who have sex with men aged 18-75 years and 20 in-depth interviews in 2013 with men aged 19-60 years. The second included 12 FGs in 2014/15 with 55 patients/service providers involved in the use/implementation of HIV self-testing or HIV prevention/care. Sexual health literacy goes well beyond individual health literacy and is enabled through complex community practices and multi-sectoral services. It is affected by emerging (and older) technologies and demands tailored approaches for specific groups and needs. The framework serves as a starting point for how sexual health literacy should be understood in the evaluation of sustainable and equitable implementation of biomedical sexual healthcare and prevention internationally.
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Affiliation(s)
- Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
- Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul Flowers
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Olivier Ferlatte
- School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Susan Patterson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Mark Gilbert
- School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
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Rosengarten M, Sekuler T, Binder B, Dziuban A, Bänziger PP. Beyond biological citizenship: HIV/AIDS, health, and activism in Europe reconsidered. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1851656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
| | - Todd Sekuler
- Institute for European Ethnology, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Beate Binder
- Institut for European Ethnology, Humboldt-Universitat Zu Berlin, Berlin, Germany
| | - Agata Dziuban
- Institute of Sociology, Jagiellonian University Faculty of Philosophy, Krakow, Poland
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McCormack H, Nathan S, Varma R, Haire B. Dissonances in communication with sexual health consumers in an inner-Sydney sexual health clinic in relation to health literacy: A mixed-methods study. Health Promot J Austr 2020; 32 Suppl 1:133-142. [PMID: 33002246 DOI: 10.1002/hpja.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 08/31/2020] [Accepted: 09/24/2020] [Indexed: 11/09/2022] Open
Abstract
ISSUES ADDRESSED This study examined the navigation of health care interactions by health consumers attending Sydney Sexual Health Centre (SSHC), an inner-city sexual health clinic in Sydney, Australia. We aimed to assess the accessibility and appropriateness of communications between SSHC and patients in the context of health literacy. METHODS We conducted 20 semi-structured interviews with health consumers, assessed health literacy using the Short Health Literacy Assessment for English-Speaking Adults (SAHL-E) and conducted a focus group with clinical staff. RESULTS We identified dissonances around assumed knowledge in communications between health professionals and health consumers, which were most apparent when lack of knowledge about sexual health, HIV and pre-exposure prophylaxis (PrEP) intersected with poor English fluency. SO WHAT?: This study suggests that existing models of access for HIV treatment and PrEP in Australia have been developed for high health literacy and may not support consumers who experience communication barriers due to low health literacy. The Australian Commission on Safety and Quality in Health Care recommends addressing health literacy systemically, including embedding assessment of health literacy into organisational systems and policies. We recommend developing tools to assess knowledge levels of consumers accessing sexual health services and incorporating health literacy into clinician training on working with patients from non-English-speaking backgrounds.
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Affiliation(s)
- Heather McCormack
- Sydney Sexual Health Centre, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia
| | - Sally Nathan
- School of Public Health and Community Medicine, University of New South Wales, New South Wales, Australia
| | - Rick Varma
- Sydney Sexual Health Centre, New South Wales, Australia.,The Kirby Institute, University of New South Wales, New South Wales, Australia
| | - Bridget Haire
- The Kirby Institute, University of New South Wales, New South Wales, Australia
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Abstract
OBJECTIVE The negative effects of HIV stigma may extend beyond those who are HIV-positive, to people who are perceived to be at risk of HIV. This article examines HIV stigma by association among Australian gay and bisexual men (GBM). DESIGN Cross-sectional, online survey of 1280 Australian gay and bisexual men. This article focuses on HIV stigma from within a larger study that investigated stigma related to sexual identity. METHODS Bivariate and multivariable comparisons were made between men who experienced HIV stigma by association and those who did not. A serial mediation model was tested to investigate relationships between GBM community attachment, sexual identity stigma, HIV testing frequency, HIV stigma by association, psychological distress, and rejection of sex partners. RESULTS Results found that 5% of participants were HIV-positive, yet over 70% reported that they had been stigmatized by others for their perceived risk of acquiring HIV. Multivariable analysis indicated that HIV stigma by association was associated with more frequent HIV testing, greater GBM community attachment, experiencing stigma related to sexual identity and psychological distress. Our results suggest flow-on effects of HIV stigma by association, such as being more likely to reject other GBM on the basis of their HIV status or not testing for HIV. CONCLUSION Our results underscore the notion that HIV stigma can have broader, negative effects on HIV-affected populations. There is a need to address HIV stigma within GBM communities and society more broadly in order to encourage HIV testing and prevention among GBM.
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Abstract
Use of crystal methamphetamine (crystal) among gay and bisexual men (GBM) has been associated with condomless anal intercourse with casual partners (CLAIC) and HIV infection. Pre-exposure prophylaxis (PrEP) and undetectable viral load (UVL) are important biomedical HIV prevention strategies. We investigate the relationship between crystal use and HIV sexual risk behaviours in the context of PrEP and UVL. In 2018, 1367 GBM provided details about crystal use and HIV prevention strategies. Binary logistic regression was used to estimate associations between crystal use and behaviour. Recent crystal use was independently associated with greater social engagement with gay men and having more sexual partners. Crystal use was also independently associated with use of PrEP and UVL among GBM who engaged in CLAIC. Although GBM who used crystal were more likely to have engaged in CLAIC, they were also more likely to use biomedical HIV prevention which mitigates against the risks of HIV infection.
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Young I, Valiotis G. Strategies to support HIV literacy in the roll-out of pre-exposure prophylaxis in Scotland: findings from qualitative research with clinical and community practitioners. BMJ Open 2020; 10:e033849. [PMID: 32350011 PMCID: PMC7213852 DOI: 10.1136/bmjopen-2019-033849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Limited understanding of pre-exposure prophylaxis (PrEP), coupled with negative public discourse, are significant barriers to its introduction. What works to support PrEP awareness and broader HIV literacy among diverse communities in the context of biomedical HIV prevention remains unclear. This article considers how PrEP can be translated across diverse communities and what the HIV literacy challenges might be in the current context of PrEP provision. SETTING We developed an HIV literacy informed community tool to support the roll-out of PrEP in Scotland. We undertook qualitative research with practitioners in urban and rural settings across nine Scottish health boards. PRIMARY OUTCOME MEASURE To examine HIV literacy challenges in the context of PrEP provision. PARTICIPANTS Interviews and focus groups with community (n=19) and clinical (n=13) practitioners working with gay and bisexual men and African communities were undertaken between March and October 2017 concerning PrEP support, stigma and HIV literacy. RESULTS HIV literacy in the context of PrEP needs to consider more than the provision of individually targeted information. Practitioners identified and responded to stratified communities and social norms of knowledge, which influenced messaging, support and informed how practitioners enabled PrEP engagement and dialogue. Social barriers in HIV literacy, including structural stigmas relating to HIV and homophobia, shaped practitioner concerns and support for community members' willingness to engage with PrEP. CONCLUSION Critical HIV literacy in the age of PrEP is a complex social practice. Attention needs to be paid to how information is provided and facilitates engagement, rather than simply what information is given.By exploring practitioner use of the Know about PrEP tool, we have shown how consideration of the patterns of access to services and information, the delivery of and support for engagement with PrEP information and the wider strategies employed to negotiate ongoing structural social barriers can support more equitable and diverse PrEP community conversations.
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Affiliation(s)
- Ingrid Young
- Centre for Biomedicine, Self and Society, Usher Institute, University of Edinburgh, Edinburgh, UK
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Hailemariam TG, Rawstorne P, Sisay MM, Nathan S. Beliefs and intention of heterosexual couples about undertaking Couple's HIV Testing and Counselling (CHTC) services in Ethiopia. BMC Health Serv Res 2020; 20:92. [PMID: 32024550 PMCID: PMC7003442 DOI: 10.1186/s12913-020-4947-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 01/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background Couples HIV Testing & Counselling (CHTC) service is an approach that may enable more people to be reached and tested for HIV. However, little is known about how couples may use this service and what they think about CHTC as an approach to finding out their HIV status. This study aimed to understand how individuals who had ever been in an ongoing heterosexual relationship for 6 months or more intended to use CHTC in Ethiopia and their beliefs about its benefits and potential harms. Methods Qualitative in-depth interviews were conducted in Addis Ababa, the capital city of Ethiopia, in 2017. Semi-structured interviews were undertaken with individuals who had ever been in an ongoing heterosexual relationship (n = 21) and key-informants (n = 11) including religious leaders, health care providers, and case managers. The interviews were transcribed verbatim, and an inductive thematic analysis was conducted. The data were coded to look for concepts and patterns across the interviews and relevant themes identified which captured key aspects related to the individual’s views on undertaking HIV testing with a sexual partner. Results Most participants regarded CHTC as an important HIV testing approach for people who are in an ongoing heterosexual relationship and expressed the view that there was “nothing like testing together”. However, many of the individual participants revealed they would prefer first to get tested alone to find out their own HIV status. They feared the consequences if they were HIV-positive, including accusations of infidelity, relationship break-up, and being exposed in the community. Many also reported being pressured to undertake CHTC before marriage by a third party, including religious institutions. Key informant interviews also discussed the requirements for CHTC before marriage. Conclusion The findings of this study suggest that people may be concerned about undertaking couples HIV testing without prior individual HIV testing. The intention of many to first test alone has policy and cost implications and underscores the possible harms of the implementation of CHTC in Ethiopia. Future research should examine whether the views identified in this qualitative study are reflected more broadly among couples in the community.
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Affiliation(s)
- Tewodros Getachew Hailemariam
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia. .,School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
| | - Patrick Rawstorne
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Sally Nathan
- School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia
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Behavioural Prevention Strategies for STI Control. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Brief Report: Changes in Behavior After PrEP Initiation Among Australian Gay and Bisexual Men. J Acquir Immune Defic Syndr 2019; 81:52-56. [PMID: 30768489 DOI: 10.1097/qai.0000000000001976] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP) has been increasingly adopted by gay and bisexual men (GBM). Little is known about whether individual GBM change their sexual behavior after PrEP initiation. METHODS Following Lives Undergoing Change (Flux) is a national, online, prospective observational study among Australian GBM. Using McNemar statistics, we compare rates of sexual behaviors before and coincident with PrEP initiation among 1518 non-HIV-positive men recruited between August 2014 and July 2017 who had not commenced PrEP at baseline and who completed at least one 6-monthly follow-up surveys by July 2018. RESULTS The proportion of men using PrEP rose to 24.2% over time. In total, 348 men initiated PrEP during follow-up. PrEP initiators were more likely to report particular sexual behaviors during the follow-up period that they commenced PrEP compared with the period immediately prior: receptive condomless anal intercourse with casual partners increased from 31.0% to 48.9% (McNemar < 0.001); mean partner number increased from 21.96 partners to 34.55 partners (p-trend < 0.001). Among the 1170 men who did not initiate PrEP, prevalence of these behaviors remained lower and stable. Sexual sensation-seeking and gay social engagement were both higher among men who commenced PrEP. CONCLUSIONS GBM tended to increase their engagement in "adventurous" sexual behaviors after PrEP initiation. Sexual behaviors among men who did not initiate PrEP were less common and did not change over time.
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Hammoud MA, Bourne A, Maher L, Jin F, Haire B, Lea T, Degenhardt L, Grierson J, Prestage G. Intensive sex partying with gamma-hydroxybutyrate: factors associated with using gamma-hydroxybutyrate for chemsex among Australian gay and bisexual men - results from the Flux Study. Sex Health 2019; 15:123-134. [PMID: 29268075 DOI: 10.1071/sh17146] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022]
Abstract
Background Gamma-hydroxybutyrate (GHB) use among gay and bisexual men (GBM) has increased in recent years. It is commonly cited as a sexual-enhancement drug. There is, however, little evidence for factors associated with GHB use or the consequences of its use among GBM. AIM Factors associated with GHB use, its relationship to sexual risk behaviour, and the contexts, consequences, and motivations for its use were examined. METHODS The Following Lives Undergoing Change (Flux) Study is an online prospective observational study of Australian GBM. At baseline, a total of 3190 GBM provided details about their use of GHB. Data on frequency, methods, pleasures and consequences of their drug use, alongside key demographic variables were collected. RESULTS Mean age was 35.0 years. One in five men (19.5%) had a history of GHB use and 5.4% reported use within the past 6 months, with 2.7% having used it monthly or more frequently. Overdose had been experienced by 14.7%, this was more common among men who used GHB at least monthly. Being HIV-positive, having more gay friends, greater social engagement with gay men who use drugs, a greater number of sexual partners, group sex, and condomless anal intercourse with casual partners were independently associated with GHB use in the past 6 months. Greater social engagement with gay men who use drugs and group sex were independently associated with at least monthly use. More frequent GHB use was independently associated with experiencing overdose among GHB users. CONCLUSION Most men used GHB infrequently and it was often used explicitly to enhance sexual experiences, often in the context of intensive sex partying. Men who used GHB frequently, were at greater risk of overdose and other negative health outcomes. GHB use should be considered alongside other drugs that have been implicated in sexual risk behaviour and HIV transmission. Harm-reduction interventions need to consider the particular impact of frequent GHB use.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Adam Bourne
- Australian Research Centre in Sex Health and Society, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
| | - Lisa Maher
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Bridget Haire
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
| | - Toby Lea
- Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia
| | - Louisa Degenhardt
- The National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King St, Sydney, NSW 2052, Australia
| | - Jeffrey Grierson
- Anglia Ruskin University, Cambridge Campus. East Rd, Cambridge CB1 1PT, UK
| | - Garrett Prestage
- The Kirby Institute, UNSW Sydney, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia
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Pleasure and HIV biomedical discourse: The structuring of sexual and drug-related risks for gay and bisexual men who Party-n-Play. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:181-190. [PMID: 31627160 DOI: 10.1016/j.drugpo.2019.09.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 08/21/2019] [Accepted: 09/23/2019] [Indexed: 11/23/2022]
Abstract
Party-n-Play (PNP) is a social practice that refers to sex that occurs under the influence of drugs. This study critically examined the risk and pleasure discourses of gay and bisexual men who PNP to explore how epistemic shifts associated with advancements in HIV biomedical sciences influence gay and bisexual men's perceptions of HIV risks and their sexual and drug-related practices. This study also aims to provide a more nuanced understanding of how sexual and drug-related risk practices of gay and bisexual men are entangled with their search for pleasure. The study was framed within poststructural Critical Discourse Analysis (CDA) methodology. In-depth one-hour interviews were conducted with 44 self-identified gay, bisexual, queer, or Two-Spirit men, who lived in Toronto, and who reported using drugs before or during sex with another man. The findings from this study demonstrated the capacity of biomedical discourses to affect respondents' HIV risk perceptions and practices. The transition from condom-centered prevention to today's context where new highly effective biomedical tools for HIV prevention are available created possibilities for greater intimacy, increased pleasure, and less anxiety about HIV tranmission, while challenging many years of preventive socialization among gay and bisexual men. However, this new context also rekindled deep-seated fears about HIV risk and viral load verifiability, reinforced unequal forms of biomedical self-governance and citizenship, and reproduced practices of biopolitics. While discourses on risk and pleasure were interwoven within complex PNP assemblages, the notion of pleasure was mobilized as a discursive tactic of self-control, and the division between normative and non-normative pleasures highlighted the consequence of biopolitical forces governing the production of discourses on sex and drugs. Future HIV social science research needs to attend to the fluid nature of the discursive environments of HIV prevention science, and consider how both the material context of PNP and its social/discursive elements operate together.
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Martinez-Lacabe A. The non-positive antiretroviral gay body: the biomedicalisation of gay sex in England. CULTURE, HEALTH & SEXUALITY 2019; 21:1117-1130. [PMID: 30601108 DOI: 10.1080/13691058.2018.1539772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 10/19/2018] [Indexed: 06/09/2023]
Abstract
Drawing on testimonies from oral history interviews, this paper analyses the implications of pre-exposure prophylaxis (PrEP) practices for gay men in England. Through perspectives on biomedicalisation, the paper focuses on three aspects relevant to the construction of technoscientific identities in the realm of HIV prevention: (i) the question of agency of PrEP users in the context of what has been defined as a biomedical intervention, (ii) practices of freedom framed within neoliberal narratives of personal responsibility versus responsibilisation and (iii) the governance of risk in the era of biomedicalisation. The paper concludes that biomedical governmentalities, even those shaped by the rhetoric of personal responsibility, can be understood as rationalities linked more to solidarity and care of the other. Despite this, the use of PrEP in England is also giving way to the configuration of new sexual scenarios shaped by zero-risk mentalities. It will be important to remain alert to the implications of zero-risk scenarios for HIV-related stigma.RésuméEn s'appuyant sur des témoignages provenant d'entretiens centrés sur des histoires orales, cet article analyse les implications des pratiques de la PrEP chez les hommes gays en Angleterre. À travers les points de vue sur la bio-médicalisation, il se concentre sur trois aspects de la construction des identités technoscientifiques dans le royaume de la prévention du VIH : i) la question de la capacité à agir des utilisateurs de la PrEP dans le contexte de ce qui a été défini comme une intervention biomédicale, ii) les pratiques de la liberté, encadrées par les récits néolibéraux sur la responsabilité personnelle, versus la responsabilisation, et iii) la gouvernance du risque à l'ère de la bio-médicalisation. En conclusion de leur article, les auteurs soutiennent que les << gouvernementalités >> biomédicales, y compris celles qui sont déterminées par la rhétorique de la responsabilité personnelle, peuvent être comprises comme des rationalités plus en rapport avec la solidarité et le souci des autres. Malgré cela, l'usage de la PrEP en Angleterre laisse la place à la configuration de nouveaux scénarios sexuels déterminés par les mentalités du risque zéro. Il est important de rester attentif aux implications des scénarios du risque zéro au regard du stigma lié au VIH.ResumenA partir de testimonios obtenidos a través de entrevistas de historia oral, el presente artículo analiza las repercusiones de la PrEP (profilaxis preexposición para el vih, por sus iniciales en inglés) en las prácticas de hombres gais en Inglaterra. Partiendo de perspectivas sobre la biomedicalización, el artículo se centra en tres aspectos pertinentes a la construcción de identidades tecnocientíficas en el ámbito de la prevención del vih: i) la cuestión de la gestión (agency) de los usuarios de la PrEP en un contexto identificado como de intervención biomédica; ii) las prácticas de libertad enmarcadas en narrativas neoliberales de responsabilidad personal versus responsabilización; iii) el manejo del riesgo en la era de la biomedicalización. El artículo concluye que los manejos biomédicos, incluso aquellos moldeados por la retórica de responsabilidad personal, pueden entenderse como racionalidades vinculadas más con la solidaridad y el cuidado de los demás. A pesar de esto, el uso de la PrEP en Inglaterra está cediendo espacio a la configuración de nuevos escenarios sexuales determinados por esquemas mentales de riesgo cero. Debemos permanecer atentos ante las implicaciones que conllevan los escenarios riesgo cero para el estigma vinculado con el vih.
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Down I, Prestage G, Brown G, Ellard J, Guy R, Hellard M, Wilson D, de Wit J, Stoové M, Holt M. Comparing Australian gay and bisexual men with undiagnosed and recently diagnosed HIV infection to those in the National HIV Registry. Sex Health 2019; 15:276-281. [PMID: 29506641 DOI: 10.1071/sh17064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 10/17/2017] [Indexed: 11/23/2022]
Abstract
Background Gay and bisexual men (GBM) with recent HIV infection are a key population to inform HIV-prevention. The National HIV Registry (NHR) provides details about all individuals diagnosed with HIV, but it is unclear how. METHODS Basic sociodemographic characteristics of GBM in the NHR who were diagnosed between 2010 and 2014 were compared with three samples of GBM: men with undiagnosed HIV infection from the Community-Based Study of Undiagnosed HIV and Testing (COUNT) study of HIV prevalence and undiagnosed infection that was conducted during 2013-14; men in the Australian Gay Community Periodic Surveys (GCPS) who were diagnosed with HIV between 2010 and 2014; and men in the HIV Seroconversion Study (SCS) who were also diagnosed in those years. RESULTS The NHR identified 3629 men who reported male-to-male sex as the exposure risk for their diagnosis between 2010 and 2014. COUNT identified 19 (8.9% of all men who tested HIV positive) men as having undiagnosed HIV. In the GCPS sample, 185 (2.5%) reported being diagnosed with HIV in 2010-14. In total, 367 men in the SCS received their diagnosis during 2010-14. The mean age of men in the NHR (36.8 years) was similar to that in GCPS (36.3 years) and SCS (35.1 years), while undiagnosed men in COUNT were younger (32.6 years), with no other significant differences between the samples. CONCLUSIONS The undiagnosed men were somewhat younger than diagnosed men. To achieve earlier diagnosis of new HIV infections, improved HIV testing frequency is needed among younger men.
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Affiliation(s)
- Ian Down
- Kirby Institute, UNSW Sydney, NSW 1466, Australia
| | | | - Graham Brown
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Vic. 3086, Australia
| | - Jeanne Ellard
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Vic. 3086, Australia
| | - Rebecca Guy
- Kirby Institute, UNSW Sydney, NSW 1466, Australia
| | - Margaret Hellard
- The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - David Wilson
- Kirby Institute, UNSW Sydney, NSW 1466, Australia
| | - John de Wit
- Centre for Social Research in Health, UNSW Sydney, NSW 1466, Australia
| | - Mark Stoové
- The Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Martin Holt
- The Australian Research Centre in Sex, Health and Society, La Trobe University, Vic. 3086, Australia
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A wager on the future: a practicable response to HIV pre-exposure prophylaxis (PrEP) and the stubborn fact of process. SOCIAL THEORY & HEALTH 2019. [DOI: 10.1057/s41285-019-00115-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Brown G, Leonard W, Lyons A, Power J, Sander D, McColl W, Johnson R, James C, Hodson M, Carman M. Stigma, gay men and biomedical prevention: the challenges and opportunities of a rapidly changing HIV prevention landscape. Sex Health 2019; 14:111-118. [PMID: 27977386 DOI: 10.1071/sh16052] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 09/26/2016] [Indexed: 11/23/2022]
Abstract
Improvements in biomedical technologies, combined with changing social attitudes to sexual minorities, provide new opportunities for HIV prevention among gay and other men who have sex with men (GMSM). The potential of these new biomedical technologies (biotechnologies) to reduce HIV transmission and the impact of HIV among GMSM will depend, in part, on the degree to which they challenge prejudicial attitudes, practices and stigma directed against gay men and people living with HIV (PLHIV). At the structural level, stigma regarding gay men and HIV can influence the scale-up of new biotechnologies and negatively affect GMSM's access to and use of these technologies. At the personal level, stigma can affect individual gay men's sense of value and confidence as they negotiate serodiscordant relationships or access services. This paper argues that maximising the benefits of new biomedical technologies depends on reducing stigma directed at sexual minorities and people living with HIV and promoting positive social changes towards and within GMSM communities. HIV research, policy and programs will need to invest in: (1) responding to structural and institutional stigma; (2) health promotion and health services that recognise and work to address the impact of stigma on GMSM's incorporation of new HIV prevention biotechnologies; (3) enhanced mobilisation and participation of GMSM and PLHIV in new approaches to HIV prevention; and (4) expanded approaches to research and evaluation in stigma reduction and its relationship with HIV prevention. The HIV response must become bolder in resourcing, designing and evaluating programs that interact with and influence stigma at multiple levels, including structural-level stigma.
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Affiliation(s)
- Graham Brown
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - William Leonard
- La Trobe University - Gay and Lesbian Health Victoria, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Anthony Lyons
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Jennifer Power
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
| | - Dirk Sander
- Deutsche AIDS-Hilfe e.V, Wilhelmstraße 138, 10963 Berlin, Germany
| | - William McColl
- AIDS United, 1424K Street, N.W., Suite 200, Washington, DC 20005, USA
| | - Ronald Johnson
- AIDS United, 1424K Street, N.W., Suite 200, Washington, DC 20005, USA
| | - Cary James
- Terrence Higgins Trust, 314-320 Gray's Inn Road, London, WC1X 8DP, UK
| | - Matthew Hodson
- GMFA, Unit 22, Eurolink Business Centre, 49 Effra Road, London SW2 1BZ, UK
| | - Marina Carman
- La Trobe University, Australian Research Centre in Sex, Health and Society, 215 Franklin Street, Melbourne, Vic. 3000, Australia
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31
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Race K, Lea T, Murphy D, Pienaar K. The future of drugs: recreational drug use and sexual health among gay and other men who have sex with men. Sex Health 2019; 14:42-50. [PMID: 27712616 DOI: 10.1071/sh16080] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
Abstract
There are complex historical connections between sexual minoritisation and desires to chemically alter bodily experience. For gay men, drug and alcohol use can be a creative or experimental response to social marginalisation - and not necessarily a problematic one in every instance. Numerous studies have found that infection with HIV and other sexually transmissible infections (STIs) is more likely among gay and men who have sex with men (MSM) who use recreational drugs than those who do not, but the causal nature of these relations is uncertain. Sexualised drug use is associated with a range of other problems, including dependence, mental health issues, accident and overdose. A growing body of work in the Alcohol and Other Drugs (AOD) field demonstrates the action of drugs and their purported effects to be a product of their relations with various other actors, contexts and practices. Given these contingencies, it is impossible to predict the future of drugs or their effect on the sexual health of gay and MSM with any degree of certainty. This article outlines some of the conditions most likely to mediate such futures in the medium term. Public funding for lesbian, gay, bisexual, transgender and queer drug issues should not remain restricted to questions of HIV prevention and sexual health. It should be expanded to equip sexual health and AOD service providers with the cultural and sexual literacy to mitigate stigma and allow them to respond constructively to drug problems among sexual and gender minorities as a matter of priority.
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Affiliation(s)
- Kane Race
- Gender & Cultural Studies, University of Sydney, SOPHI A14, University of Sydney, Sydney, NSW 2006, Australia
| | - Toby Lea
- Centre for Social Research in Health, The University of New South Wales, John Goodsell Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Dean Murphy
- Centre for Social Research in Health, The University of New South Wales, John Goodsell Building, UNSW Australia, Sydney, NSW 2052, Australia
| | - Kiran Pienaar
- National Drug Research Institute, Curtin University, Suite 6, 19-35 Gertrude Street, Fitzroy, Vic. 3065, Australia
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32
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Promoting 'Equitable Access' to PrEP in Australia: Taking Account of Stakeholder Perspectives. AIDS Behav 2019; 23:1846-1857. [PMID: 30306435 DOI: 10.1007/s10461-018-2311-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As evidence of the safety and effectiveness of HIV pre-exposure prophylaxis (PrEP) has grown, so has attention to the views of prospective users and providers. However, far less attention has been paid to understanding the perspectives of other stakeholders in the rollout of PrEP access programs. We conducted 21 semi-structured qualitative interviews in 2017 with key stakeholders working across the policy, advocacy, research and/or clinical dimensions of the Australian HIV response, before federal support for a subsidised access scheme was achieved. Our analysis explored three areas of shared concern: who is a suitable candidate for PrEP; why are disparities in PrEP access important; and how can disparities be addressed? In examining how this diverse group of professionals grappled with the challenges of promoting 'equitable access' to PrEP in an increasingly resource rationed health system, we can see how the principles believed to underpin the Australian response to HIV were both reaffirmed and challenged through this period of significant change.
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HIV Pre-exposure Prophylaxis (PrEP) Uptake Among Gay and Bisexual Men in Australia and Factors Associated With the Nonuse of PrEP Among Eligible Men: Results From a Prospective Cohort Study. J Acquir Immune Defic Syndr 2019; 81:e73-e84. [DOI: 10.1097/qai.0000000000002047] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Lazuardi E, Newman CE, Tasya IA, Rowe E, Wirawan DN, Wisaksana R, Subronto YW, Kaldor J, Kusmayanti NA, Iskandar S, Bell S. Understanding the Social Influences on Engaging Key Populations With HIV Prevention: A Qualitative Study With Men Who Have Sex With Men in Three Indonesian Cities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:206-223. [PMID: 31145004 DOI: 10.1521/aeap.2019.31.3.206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The globally recognized test and treat approach underpins Indonesian national strategies to reduce and prevent HIV among key populations, including men who have sex with men. More comprehensive understanding of how engagement with HIV prevention is shaped by social and community practices will support these efforts. Between 2015 and 2016, focus groups and semi-structured interviews were conducted with 54 men who have sex with men in three urban settings in Indonesia to elicit their views on, and experiences of, HIV prevention and care. Focused on data relating to testing, findings documented the important influence of informal peer networks, community-based organizations and outreach workers. Some social dimensions of service access complicated this, particularly fear of stigma or lack of confidentiality in large service settings. The many differences between men challenges assumptions that a single set of HIV prevention strategies will work to engage all men who have sex with men living in Indonesia.
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Affiliation(s)
- Elan Lazuardi
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Irma Anintya Tasya
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Emily Rowe
- Yayasan Kerti Praja, Denpasar, Indonesia
| | - D N Wirawan
- Yayasan Kerti Praja, Denpasar, Indonesia
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia
| | - Rudi Wisaksana
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Yanri W Subronto
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - John Kaldor
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Nur Aini Kusmayanti
- Centre for Tropical Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Shelly Iskandar
- Clinical Infectious Diseases Research Centre, Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia
| | - Stephen Bell
- The Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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35
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Girard G, Patten S, LeBlanc MA, Adam BD, Jackson E. Is HIV prevention creating new biosocialities among gay men? Treatment as prevention and pre-exposure prophylaxis in Canada. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41:484-501. [PMID: 30450606 DOI: 10.1111/1467-9566.12826] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The advancements of "treatment as prevention" (TasP), "undetectable viral load" (UVL) and "pre-exposure prophylaxis" (PrEP) are redefining HIV prevention standards. Relying on the concept of biosociality, this article explores how gay men rally around, debate, and sometimes disagree about these emerging HIV prevention technologies. This article is based on data from the Resonance Project, a Canadian community-based research project. Twelve focus groups (totalling 86 gay and bisexual men) were held in three Canadian cities (Montreal, Toronto, Vancouver) in 2013-2014. Respondents view UVL and PrEP through the prism of their generational experience of HIV prevention. In this respect, biosocialities highlight an experiential dimension that is tied to the context of the HIV epidemic. The biosocialities of HIV prevention are also built around serological identities. However, our study shows the diversity of these positions. Analysis grounded in biosocialities is useful for better understanding how scientific information circulates, is made sense of, and generates debate among gay men.
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Affiliation(s)
- Gabriel Girard
- School of Public Health, University of Montreal, Montreal, QC, Canada
| | - San Patten
- San Patten and Associates, Inc., Halifax, Canada
| | | | - Barry D Adam
- Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON, Canada
- CATIE, Toronto, ON, Canada
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36
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Bhargava S, Moen K, Qureshi SA, Hofvind S. Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis. Acta Radiol 2018; 59:1285-1291. [PMID: 29451023 DOI: 10.1177/0284185118758132] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Groups of immigrant and minority women are more often diagnosed with advanced stage breast cancer than other women. Mammographic screening aims to reduce mortality from breast cancer through early detection in asymptomatic women. Purpose To compare mammographic screening attendance among immigrant and minority women to that of other women. Material and Methods A literature search of PubMed, Embase, Google Scholar, and Cochrane identified 1369 papers published between January 1995 and March 2016. In the review, we included 33 studies investigating mammographic screening attendance among immigrant and/or minority women. In a meta-analysis, we included 19 of the studies that compared attendance among immigrant and/or minority women with that among other women, using a random effects model. Results The review included studies from Europe, North America, and Oceania, with 42,666,093 observations of opportunities for mammographic screening. Attendance was generally lower among immigrant and minority women compared to other women (46.2% vs. 55.0%; odds ratio = 0.64, 95% confidence interval = 0.56-0.73; P < 0.05, I2 = 99.9%). Non-Western immigrants had lower attendance rates than other immigrants. Conclusion Immigrant and minority women had lower mammographic screening attendance than other women, which could potentially put them at increased risk for more advanced breast cancer. This review emphasizes the importance of continued efforts to engage with the preventative health needs of diverse populations in attempts to achieve equality in access to, and use of, care.
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Affiliation(s)
- Sameer Bhargava
- Cancer Registry of Norway, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Samera Azeem Qureshi
- Norwegian Centre for Minority and Migrant Health Research, Oslo University Hospital, Oslo, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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37
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Slavin S. HIV Treatment as Prevention: Implications for Health Promotion. Health Promot Int 2018; 33:325-333. [PMID: 28334739 DOI: 10.1093/heapro/daw080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Evidence has been accumulating in recent years that individuals with HIV who are effectively treated with antiretroviral drugs are highly unlikely to transmit the virus to their sexual partners. This approach has great potential to contribute to ongoing prevention efforts and has been termed 'treatment as prevention'. International political momentum has been building in recent years to attempt to significantly reduce new HIV infections globally and end the epidemic by 2030. In pursuit of such aims a number of local health authorities and communities have adopted intensified 'test and treat' strategies to quickly diagnose infections and reduce the risk of onward transmission through an immediate offer of treatment. These have most commonly been driven through enhancements to clinical services and health promoters have been engaged in limited ways. People with HIV often have high rates of health literacy and are now expressing interest in knowing more about how treatment as prevention might work to reduce their individual risk of sexual transmission. For some this represents an added risk reduction measure and for others it may replace condoms. There is currently an opportunity for health promotors to engage with this approach both to exploit its prevention benefits and to counter the stigma that attaches to HIV infectiousness. It is hoped that any reduction in stigma and fear of transmission will help improve the quality of social and sexual relationships among affected groups.
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Affiliation(s)
- Sean Slavin
- Centre for Social Research in Health, University of New South Wales, Australia
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38
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Koester KA, Erguera XA, Kang Dufour MS, Udoh I, Burack JH, Grant RM, Myers JJ. "Losing the Phobia:" Understanding How HIV Pre-exposure Prophylaxis Facilitates Bridging the Serodivide Among Men Who Have Sex With Men. Front Public Health 2018; 6:250. [PMID: 30238001 PMCID: PMC6135985 DOI: 10.3389/fpubh.2018.00250] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 08/15/2018] [Indexed: 01/27/2023] Open
Abstract
The use of HIV serostatus information has played a pivotal role in partner selection norms. A phenomenon known as serosorting is the practice of selecting a partner based on a perception that they are of the same HIV status in order to avoid transmission from one partner to the other. An understudied aspect of serosorting is that it has a divisive effect-one accepts or rejects a potential partner based on a singular characteristic, the partner's HIV status, and thus excludes all others. This division has been formally referred to as the HIV serodivide. In this study, we explored partner selection strategies among a group of HIV-negative, young men who have sex with men (n = 29) enrolled in a PrEP demonstration project in Northern California. We found that trends in serosorting were in fact shifting, and that a new and opposite phenomenon was emerging, something we labeled "seromixing" and that PrEP use played a part in why norms were changing. We present three orientations in this regard: (1) maintaining the phobia: in which men justified the continued vigilance and exclusion of people living with HIV as viable sex or romantic partners, (2) loosening/relaxation of phobia: among men who were reflecting on their stance on serosorting and its implications for future sexual and/or romantic partnerships, and (3) losing the phobia: among men letting go of serosorting practices and reducing sentiments of HIV-related stigma. The majority of participants spoke of changing or changed attitudes about intentionally accepting rather than rejecting a person living with HIV as a sex partner. For those who maintained strict serosorting practices, their understandings of HIV risk were not erased as a result of PrEP use. These overarching themes help explain how PrEP use is contributing to a closing of the HIV serodivide.
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Affiliation(s)
- Kimberly A Koester
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Xavier A Erguera
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Mi-Suk Kang Dufour
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Ifeoma Udoh
- East Bay AIDS Center, Sutter Health, Oakland, CA, United States
| | | | - Robert M Grant
- Virology and Immunology, Gladstone Institutes, University of California, San Francisco, San Francisco, CA, United States
| | - Janet J Myers
- Division of Prevention Science, Center for AIDS Prevention Research, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Girard G, Doré V. Thirty Years of Research on Gay Men and HIV Prevention in France: A Narrative Review of the Literature. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1341-1349. [PMID: 29417262 DOI: 10.1007/s10508-018-1163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/16/2017] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
Research on homosexuality and HIV/AIDS in the social sciences has evolved into a vast and multiform field of study since the beginning of the epidemic in the Global North. Studies from France in this domain have remained relatively unknown at the international level. This article offers a narrative review of publications that resulted from research on homosexuality and HIV/AIDS, from 1985 to 2016. It offers an analysis of how the constitution of a field of research conditions the ways scientific questions are asked (and answered). This epistemological concern is addressed through a sociohistorical contextualization of the main issues surrounding prevention and how they have been addressed by researchers in France. A review of French publications on HIV prevention among gay men reveals certain specificities. In terms of the social science disciplines, psychology and psychoanalysis are much less present in this domain, whereas epidemiology, sociology, and anthropology are the most represented. The works analyzed in this article also reveal the circulation and local adaptations of risk categories imported from the English-speaking world, such as "relapse" and "bareback." Regardless, research on HIV prevention in France largely evolved contemporaneously in the same way that it did elsewhere.
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Affiliation(s)
- Gabriel Girard
- Institut de Recherche en Santé Publique de l, Université de Montréal, 7101 Avenue du Parc, Montreal, QC, H3N 1X9, Canada.
| | - Véronique Doré
- Agence Nationale de Recherche sur le Sida et les hépatites virales, Paris, France
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40
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Fraser S. Do practice approaches go far enough in shifting focus from the individual? Addiction 2018; 113:215-216. [PMID: 28975681 DOI: 10.1111/add.14018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Suzanne Fraser
- Social Studies of Addiction Concepts Research Program, National Drug Research Institute, Faculty of Health Sciences, Curtin University, Melbourne, Australia.,Centre for Social Research in Health, Faculty of Arts and Social Sciences, University of New South Wales, Sydney, Australia
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Hammoud MA, Jin F, Lea T, Maher L, Grierson J, Prestage G. Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results From the FLUX Study. J Sex Med 2017; 14:774-784. [PMID: 28583339 DOI: 10.1016/j.jsxm.2017.04.670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 04/16/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Gay and bisexual men (GBM) use oral erectile dysfunction medications (EDMs) often with little evidence of medical indication necessitating their use. AIM To investigate the prevalence, contexts, and motivations for oral EDM use and its relation to sexual risk behavior. METHODS A total of 2,250 Australian GBM completed an online survey of licit and illicit drug use and their associated behaviors. Multivariate logistic regression analysis identified factors associated with use of EDMs in the previous 6 months and, for those who had used EDMs, factors associated with use on a weekly basis. OUTCOMES Any EDM use and at least weekly use in the previous 6 months. RESULTS The median age of the sample was 33.0 years (range = 16-81). Two thirds (67.7%) reported no lifetime history of EDM use. Approximately 1 in 10 participants (11.1%) had last used an EDM more than 6 months previously. In the previous 6 months, 11.5% reported using EDMs less than monthly, 5.3% reported using EDMs approximately monthly, and 4.5% reported using EDMs at least weekly. Of men who had used EDMs in the previous 6 months, common reasons cited for its use were to maintain an erection for longer (73.3%), to make it easier to "get hard" (67.3%), and difficulty in attaining or maintain an erection (53.5%). Use of EDMs in the previous 6 months was associated with illicit drug use and higher rates of sexual risk behavior. Weekly users were more likely to have severe anxiety than less frequent users. CLINICAL TRANSLATION The use of EDMs in the context of intensive sex partying, with the associated potential for increased risk of HIV transmission and illicit drug use, indicates a need to consider the use of EDMs among GBM in HIV prevention and minimizing harm. STRENGTHS AND LIMITATIONS This large-scale study of drug use among GBMs includes comprehensive detailed data on their history of use and rationales for use. Our online methodology potentially decreases social desirability bias in reporting illegal or stigmatized behaviors. This volunteer online convenience sample might not be representative of all GBMs in Australia. CONCLUSION GBMs who used an oral EDM in the previous 6 months often used it for recreational purposes, but many of those who used it on a weekly basis also might have used it for therapeutic reasons. GBMs often use EDMs to enhance their sexual experiences often in the context of intensive sex partying (which can include risky sexual behavior). Hammoud MA, Jin F, Lea T, et al. Off-Label Use of Phosphodiesterase Type 5 Inhibitor Erectile Dysfunction Medication to Enhance Sex Among Gay and Bisexual Men in Australia: Results From the FLUX Study. J Sex Med 2017;14:774-784.
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Affiliation(s)
- Mohamed A Hammoud
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia.
| | - Fengyi Jin
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | - Toby Lea
- Centre for Social Research in Health, University of New South Wales, Kensington, NSW, Australia
| | - Lisa Maher
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
| | | | - Garrett Prestage
- The Kirby Institute, University of New South Wales, Kensington, NSW, Australia
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Bhargava S, Tsuruda K, Moen K, Bukholm I, Hofvind S. Lower attendance rates in immigrant versus non-immigrant women in the Norwegian Breast Cancer Screening Programme. J Med Screen 2017; 25:155-161. [DOI: 10.1177/0969141317733771] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Objective The Norwegian Breast Cancer Screening Programme invites women aged 50–69 to biennial mammographic screening. Although 84% of invited women have attended at least once, attendance rates vary across the country. We investigated attendance rates among various immigrant groups compared with non-immigrants in the programme. Methods There were 4,053,691 invitations sent to 885,979 women between 1996 and 2015. Using individual level population-based data from the Cancer Registry and Statistics Norway, we examined percent attendance and calculated incidence rate ratios, comparing immigrants with non-immigrants, using Poisson regression, following women's first invitation to the programme and for ever having attended. Results Immigrant women had lower attendance rates than the rest of the population, both following the first invitation (53.1% versus 76.1%) and for ever having attended (66.9% versus 86.4%). Differences in attendance rates between non-immigrant and immigrant women were less pronounced, but still present, when adjusted for sociodemographic factors. We also identified differences in attendance between immigrant groups. Attendance increased with duration of residency in Norway. A subgroup analysis of migrants' daughters showed that 70.0% attended following the first invitation, while 82.3% had ever attended. Conclusions Immigrant women had lower breast cancer screening attendance rates. The rationale for immigrant women's non-attendance needs to be explored through further studies targeting women from various birth countries and regions.
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Affiliation(s)
- Sameer Bhargava
- Cancer Registry of Norway, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Kåre Moen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida Bukholm
- Norwegian System of Compensation to Patients, Oslo, Norway
- Department of Landscape Architecture and Spatial Planning, Faculty of Social Sciences, Norwegian University of Life Sciences, Oslo, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Ferraz D, Paiva V. Sex, human rights and AIDS: an analysis of new technologies for HIV prevention in the Brazilian context. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 18 Suppl 1:89-103. [PMID: 26630300 DOI: 10.1590/1809-4503201500050007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 01/22/2015] [Indexed: 11/22/2022] Open
Abstract
Worldwide, HIV prevention is challenged to change because clinical trials show the protective effect of technologies such as circumcision, preexposure prophylaxis, and the suppression of viral load through antiretroviral treatment. In the face of demands for their implementation on population levels, the fear of stimulating risk compensation processes and of increasing riskier sexual practices has retarded their integration into prevention programs. In this article, following a narrative review of the literature on risk compensation using the PubMed database, we offer a critical reflection on the theme using a constructionist approach of social psychology integrated to the theoretical framework of vulnerability and human rights. The use of biomedical technologies for prevention does not consistently induce its users to the increase of riskier practices, and variations on the specificity of each method need to be carefully considered. Alternatives to the theories of sociocognitive studies, such as social constructionist approaches developed in the social sciences and humanities fields, indicate more comprehensive interpretations, valuing the notions of agency and rights. The critical analysis suggests priority actions to be taken in the implementation process: development of comprehensive programs, monitoring and fostering dialog on sexuality, and technical information. We highlight the need to implement a human rights-based approach and to prioritize dialog, stressing how complementary these technologies can be to meet different population needs. We conclude by stressing the need to prioritize sociopolitical changes to restore participation, dialog about sexuality, and emphasis on human rights such as core elements of the Brazilian AIDS policy.
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Affiliation(s)
- Dulce Ferraz
- Escola FIOCRUZ de Governo, Diretoria Regional de Brasília da Fundação Oswaldo Cruz, Brasília, DF, Brazil
| | - Vera Paiva
- Study Group for the Prevention of AIDS, Universidade de São Paulo, São Paulo, SP, Brazil
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Down I, Ellard J, Bavinton BR, Brown G, Prestage G. In Australia, Most HIV Infections Among Gay and Bisexual Men are Attributable to Sex with 'New' Partners. AIDS Behav 2017; 21:2543-2550. [PMID: 28283774 DOI: 10.1007/s10461-017-1747-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
It has been estimated that the majority of global HIV infections among gay and bisexual men (GBM) can be attributed to sex within a committed relationship. In Australia, however, negotiated safety, whereby HIV-negative regular partners agree to discard condoms with each other but commit to consistent condom use with other partners, has been promoted as a key component of the HIV prevention response. We asked GBM recently diagnosed with HIV to describe their relationship to the person they believed to be the source of their infection ('source person'). The majority (66.1%) ascribed their infection to a casual partner. A further 23.3% ascribed their infection to a non-committed and non-romantic partner (or 'fuckbuddy'). Only 10.6% believed they had acquired their HIV from a 'boyfriend' in the context of a committed romantic relationship, and 51.7% of these occurred within the first 3 months following their first sexual contact. Most men (61.5%) believed they had acquired their HIV infection on the first occasion they had sex with the source person. In the Australian context, negotiated safety appears to have minimised infections between regular partners. However, many HIV infections between regular partners may not be in the context of a romantic committed relationship, and yet this distinction between types of regular partners has been all but ignored. Furthermore, in this sample, most infections occurred on the occasion of first meeting, suggesting that the most useful indicators of risk may be the characteristics, contexts, and lengths of sexual partnerships and how sex is negotiated, rather than how GBM categorize their partner. Findings suggest more new HIV infections occur in new partnerships, than in established relationships.
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Affiliation(s)
- Ian Down
- The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia.
| | - Jeanne Ellard
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Australia
| | | | - Graham Brown
- Australian Research Centre in Sex Health and Society, La Trobe University, Melbourne, Australia
| | - Garrett Prestage
- The Kirby Institute, UNSW Australia, Sydney, NSW, 2052, Australia
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Kippax S. A journey to HIV prevention research: From social psychology to social health via multidisciplinarity. J Health Psychol 2017; 23:442-456. [PMID: 28810461 DOI: 10.1177/1359105317707529] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
This is a personal account of my research in HIV prevention from 1984 to the present day. It demonstrates my disquiet with the individualism of psychology as a way of thinking about what was needed to prevent HIV transmission. HIV prevention requires social transformation which is produced via changes in social practices and norms of communities and networks rather than by changes in behaviours of individuals. My colleagues and I developed a 'social health' model of social transformation that involves enabling communities to modify their social practices by building on emergent community responses, responses that were identified by the use of a reflexive research methodology.
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Redoschi BRL, Zucchi EM, Barros CRDS, Paiva VSF. Routine HIV testing in men who have sex with men: from risk to prevention. CAD SAUDE PUBLICA 2017; 33:e00014716. [PMID: 28538786 DOI: 10.1590/0102-311x00014716] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/01/2017] [Indexed: 11/22/2022] Open
Abstract
We conducted a critical review of the literature on recurrent use of HIV testing in men who have sex with men (MSM). We performed a narrative review of the literature in which we analyzed the various conceptions on frequent testing over time, the implications for health programs, and the main social markers that influence the incorporation of HIV testing as routine care. Although it has existed since the 1990s, recurrent testing among MSM was frequently interpreted as increased exposure to HIV due to lack of condom use, and therefore as "unnecessary" testing. Beginning in the 2000s, periodic testing has become a programmatic recommendation and has been interpreted as a goal. Individuals' perception of their use of the test has rarely been considered in order to characterize such use as routine care. On the social and cultural level, individual aspects associated with recent or routine testing were included in contexts of favorable norms for testing and less AIDS stigma. Differences in generation, schooling, and types of affective-sexual partnerships play an important part in testing. Such differences highlight that the epidemiological category "men who have sex with men" encompasses diverse relations, identities, and practices that result in specific uses of the test as a prevention strategy. Thus, dialogue between programs, health professionals, and the persons most affected by the epidemic is crucial for building responses with real potential to confront the HIV epidemic, based on respect for human rights.
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Affiliation(s)
| | - Eliana Miura Zucchi
- Programa de Pós-graduação Stricto Sensu em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
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Abstract
This review considers Australia's progress towards the elimination of HIV and AIDS, as specified in international targets. In particular, it considers the reaction to recent media reports that Australia has 'ended AIDS' and evaluates progress towards reducing HIV transmission. Recent surveillance data and research show significant improvements in HIV testing and treatment, but countervailing trends such as increased condomless sex between gay and other men who have sex with men. Pre-exposure prophylaxis (PrEP) is being implemented at scale in some jurisdictions, with the hope that this will significantly alter the trajectory of Australia's HIV epidemic, which has been stable for the last five years (at around 1000-1100 infections per year). The ongoing challenge in maintaining investment, while also considering how to respond to the diversification of the local epidemic, means that Australia has entered a critical period in which evidence of PrEP's impact is eagerly awaited.
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Affiliation(s)
- Martin Holt
- Centre for Social Research in Health, UNSW Australia, Level 2, John Goodsell Building, Sydney, NSW, 2052, Australia.
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Leblanc NM, Mitchell JW, De Santis JP. Negotiated safety - components, context and use: an integrative literature review. J Adv Nurs 2017; 73:1583-1603. [PMID: 27906471 DOI: 10.1111/jan.13228] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to examine the components and use of negotiated safety in the context of HIV prevention and to identify reported factors associated with the concept. BACKGROUND There is an emerging interest in dyadic approaches to address HIV transmission. Although there are theoretical foundations for how interpersonal relationships influence individual behaviour, how these dyadic processes influence on health is still not wholly understood. DESIGN Integrative review of empirical and theoretical literature. DATA SOURCES The Cumulative Index for Nursing and Allied Health Literature (CINAHL) MEDLINE and PsychINFO electronic databases were accessed. REVIEW METHODS Articles were read to gain a historical context of the term and identify varying interpretations of the concept. Factors warranting consideration in association with NS were identified and clinical and public health implications were noted. RESULTS Forty-eight studies were reviewed. Negotiated safety included the following components: (i) HIV sero-negative concordant men within a primary relationship; (ii) joint HIV screening and mutual disclosure of their HIV status; (iii) explicit relationship boundaries which establish either nonexclusively that allows for the dispensing of condoms within the primary relationship and consistent condom use for extra-dyadic sex; or dispensing of condoms within a primary partnership and exclusivity; and (iv) a breach clause that allows communication to re-establish the agreement if needed. CONCLUSION Negotiated safety is a prescriptive approach to HIV risk reduction among couples. Researchers and practitioners could benefit from promoting this approach to HIV prevention.
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Affiliation(s)
- Natalie M Leblanc
- School of Nursing and Health Sciences, University of Miami, Florida, USA
| | - Jason W Mitchell
- Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Joseph P De Santis
- Graduate Programs, School of Nursing and Health Sciences, University of Miami, Florida, USA
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Rance J, Rhodes T, Fraser S, Bryant J, Treloar C. Practices of partnership: Negotiated safety among couples who inject drugs. Health (London) 2016; 22:3-19. [PMID: 27491943 DOI: 10.1177/1363459316660859] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite the majority of needle-syringe sharing occurring between sexual partners, the intimate partnerships of people who inject drugs have been largely overlooked as key sites of both hepatitis C virus prevention and transmission, and risk management more generally. Drawing on interviews with 34 couples living in inner-city Australia, this article focuses on participants' accounts of 'sharing'. While health promotion discourses and conventional epidemiology have tended to interpret the practice of sharing (like the absence of condom use) in terms of 'noncompliance', we are interested in participants' socially and relationally situated 'rationalities'. Focussing on participants' lived experiences of partnership, we endeavour to make sense of risk and safety as the participants themselves do.How did these couples engage with biomedical knowledge around hepatitis C virus and incorporate it into their everyday lives and practices? Revisiting and refashioning the concept of 'negotiated safety' from its origins in gay men's HIV prevention practice, we explore participants' risk and safety practices in relation to multiple and alternative framings, including those which resist or challenge mainstream epidemiological or health promotion positions. Participant accounts revealed the extent to which negotiating safety was a complex and at times contradictory process, involving the balancing or prioritising of multifarious, often competing, risks. We argue that our positioning of participants' partnerships as the primary unit of analysis represents a novel and instructive way of thinking about not only hepatitis C virus transmission and prevention, but the complexities and contradictions of risk production and its negotiation more broadly.
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Affiliation(s)
- Jake Rance
- Centre for Social Research in Health, UNSW Australia, Australia
| | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene & Tropical Medicine, UK
| | - Suzanne Fraser
- National Drug Research Institute, Curtin University, Australia
| | | | - Carla Treloar
- Centre for Social Research in Health, UNSW Australia, Australia
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Abstract
What is the relationship between social action initiatives and theory? In this paper we suggest that, like social action, theory is a means of intervening in social problems and is integrally linked with future possibilities. Devising the means of effective intervention requires the ability to understand and harness people's ways of actively striving to deal with the social problems which emerge in their everyday lives. Such efforts involve communicating across difference. For example, regarding the problems of HIV prevention and positive living, gay men in Sydney are positioned differently from each other in relation to the virus, sexual practice, understanding and use of biomedical developments in the development of safe-sex strategies. How do everyday struggles to communicate across difference feed into effective social action, and what is the role of theory in supporting and driving these efforts? In this paper we consider the limitations of notions of intersubjectivity which overemphasize the role of ‘mutual recognition’ in the development of relationships between actors. Talk of ‘mutual recognition’ overlooks the fact that communication is essentially ambiguous. The result is a failure to theorize the emergence of productive connections between people which work through openness to this ambiguity. The absence of recognition can give rise to confusion, but it also an important element in the development of new ways of connecting with others. In turn, the mechanisms of socio-political change can be affected through the development of new forms of connection between actors. That is, modes of intersubjectivity which are based on misrecognition and difference can function as transfiguring relations, opening new possibilities for actively tackling social problems. We argue that effective social action harnesses transfiguring relations. This approach to social action demands that we develop our understanding of social relations, and take account of the productive role of misrecognition.
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